Joseph D. Lichtenberg, M.D.: Synthesizer Extraordinaire: A Conversation with Joseph D. Lichtenberg at His Home in Bethesda, MD, April 11, 2021

ABSTRACT

A little over five weeks before Joseph Lichtenberg’s death, I conducted an interview to discuss Joe’s new ideas about the importance of tracking a sense of power in patients’ experiences and in clinical interactions. At the time, we were aware that Joe was dying and his time was short. He also wanted to hear from me concerning my experience at the time we had first begun a supervisory relationship 33 years ago. He shared his impression of me from that time. We go on to discuss a few of his contributions, especially the concepts of wearing the attribution and the joint construction of model scenes – concepts that have become part of the contemporary psychoanalytic lexicon. Finally, we discuss Joe’s legacy to psychoanalysis involving a way of thinking and a willingness to shift if a better idea emerges.

KEYWORDS:

• Motivation
• motivational systems
• power
• experience
• autism
• model scene

Introduction

I am honored to have interviewed Joseph Lichtenberg for this issue of Psychoanalytic Inquiry. Our conversation occurred a little over five weeks before his death on May 19, 2021. At the time, we were aware the end was coming and we appreciated the opportunity to share this moment to discuss Joe’s career as a master psychoanalyst and theoretical innovator as well as to review our long relationship. I only hope the transcript of our interview captures Joe’s vitality as he described his evolving thinking about power – specifically about the importance of tracking a patient’s sense of power – that continued right up to the very end of Joe’s long life.

Joe became my supervisor in 1988 and we worked together for many years in the roles of supervisor and supervisee. Along the way, Joe invited me to present a case at the inaugural conference of the Institute of Contemporary Psychotherapy and Psychoanalysis (ICP+P).¹ The conference title, created by Joe, in his usual style of inquiry, was: “Is Shame the Central Affect of Disorders of the Self?” I provided a clinical presentation and shame experts discussed my paper. Afterward, Joe suggested that this might make a good issue for Psychoanalytic Inquiry and invited me to develop such an issue and the contributors included Andrew Morrision, Melvin Lansky, Benjamin Kilborne, Leon Wurmser, and a few others. The issue was published in 1999 and Joe contributed a paper that reviewed the entire issue. Several of the discussants critiqued my work, particularly regarding what they saw as my failure to address the patient’s more primitive motivations. In Joe’s discussion, while acknowledging his role as my supervisor as well as for suggesting the issue, he went on to cogently analyze and synthesize all the discussions, present his viewpoints, and then go on to affirm me as both a writer and a clinician.² Receiving this affirmation and support from Joe significantly bolstered my confidence. Like with so many others, Joe was instrumental in guiding me to expand my thinking, encouraging me to develop my own ideas and, importantly, to become a writer. He invited me to join the Editorial Board of Psychoanalytic Inquiry and later appointed me to serve as an Associate Editor.

Over the years, Joe and I became friends and enjoyed many good times together. During the pandemic, we spoke regularly and he excitably told me that he was working on some new ideas. In his usual spirit of generosity, Joe wanted to share these ideas with our ICP+P community and I helped to organize what was to be Joe’s last public talk on January 13, 2021.

On March 6, 2021, Psychoanalytic Inquiry held its editorial Board Meeting via Zoom and Joe was at the top of his game, leading our discussions as issue editors shared ongoing projects, he invited new ideas for issues and, as was his wont, creatively suggested topics for future issues. It was an invigorating, thought-provoking, and satisfying meeting.

Following the editorial board meeting, there was a flurry of activity involving e-mails from Joe to Mel Bornstein, who, at the time, served as editor of the journal, and to the associate editors. As the month progressed, though, Joe became quiet and I was concerned. I reached out only to learn the sad news that Joe’s health had seriously deteriorated and he now required full-time nursing care. On a phone conversation in late March, Joe told me he believed he was dying. While his mind remained sharp, his body was rapidly failing. Over the weeks between late March and May 9, 2021, I visited Joe regularly and recorded the following interview on April 11, 2021.

“I would hope my legacy would include a way of thinking … Synthesizer—that’s the right word. I see a relationship between this and this and this and then I find some commonality … I will change any idea at any time if a better or clearer idea comes to me.”

—Joseph D. Lichtenberg, April 11, 2021

The conversation

E)

I’m here for us to talk together and to interview you for what will be an issue in Psychoanalytic Inquiry, your baby.

J)

Alright.

E)

You said you have new ideas you’re developing. Tell me about those ideas, let me get them down.

J)

First is the idea that you switch when a sense of power diminishes. There are a whole number of things you automatically do to switch, completely, automatically and without reflection, in order to activate another means of a sense of power. Like running away. This new idea one has to do with becoming depressed. You switch into depression.

Traditionally the way to approach that is to identify what is the trigger for the depression. And if you understood the trigger and connected it to the dynamics of your life, that would remedy the situation. I’m saying that is true to a degree but the real leverage has to do not with the trigger but with the hope, to the degree that you maintain hope, you have the possibility of moving through the depression. To the degree that there is no sense of hope, you are stuck. In the treatment, rather than a primary focus on the triggering event, if you switch and you primarily go to where the sense of hope is, you will then be investigating that which provides the dynamic.

E)

You investigate the hope – what can activate hope?

J)

Essentially, investigate where is the hope.

E)

What if it’s lost?

J)

Then you say, when was the sense of hope lost. Essentially, you are tracking the experience hope. How you are dealing with hope? When did you have it, when did you lose it?

E)

Tracking where hope is, if it’s there, not there, what restores it? All of that?

J)

That’s where the dynamic thrust is. That changes treatment.

E)

You mentioned this to me on the phone last week.

J)

And, the second idea is …

E)

Before we talk about the second idea, let’s talk about how this focus on the experience of hope changes the dynamic approach. How do you see it changing the dynamic approach in the room?

J)

It moves from a primary focus on the event to a primary focus on the ups and downs of the hope which involves the expectation that something can change for the better. You can work with a person by saying, do you think of yourself as a person who generally has high hopes? Like, for example, when you were an adolescent, did you have high hopes that you could achieve your goals? A sense of having hope can then become a characteristic of the person that is very meaningful to that person, who may not even know it.

E)

So, it becomes a characteristic of the person who may not know it, operating implicitly?

J)

Yes. That’s one. The second is what I think of as an extremely important as a factor in attunement is the sense of being with.

E)

Yes.

J)

What we refer to as a sense of being alone in the presence of the other.

E)

Sense of being with, so you are not alone. A sense of being in it together.

J)

Like, the patient says, “Over the weekend I ran into this difficulty but I had the feeling you were there with me and it helped me a lot.” So being carried with the patient is a very important component of an ongoing treatment. But the treatment is coming to an end and you have a fear that it will fail, fail over time. There is a way through fantasy, I am not to lose you and you not to lose me. And that fantasy is through adoption – you will adopt me which I have done with people all over the bloody world! (Laughs). So, adoption Is the fantasy that replaces the other because adoption has no end. Because adoption has the desirability for the person of being never ending. The very first patient I saw, a young woman who came to Sheppard (Sheppard Pratt Hospital).

E)

As an inpatient?

J)

Yes, she was very psychotic and we worked together very well. And she certainly had the feeling of me being with her. Her parents yanked her out of hospital. She had a fantasy about me and I think it was that I would literally adopt her and take her to my home. So, the family yanked her out against advice.

E)

They were worried about her fantasy of you adopting her? So, the family believed you would literally adopt her – they were very threatened?

J)

Her parents took her out against advice and wouldn’t let her get back into treatment. About four months later, she committed suicide. It was shocking. So, adoption fantasies are different from fantasies of having you with me. Fantasy of having you with me can be illusion while fantasy of adoption is set, the bond is set.

E)

Tell me about the people you’ve adopted all around the world.

J)

There’s Ron Bodansky.³ Another is a family in Annapolis who visit and sail with me, treat me as grandfather to their children.

E)

Am I in the adopted group? (laughing)

J)

Absolutely! A man in Australia. And, so on. There must be something about me that influences this, something that I’m perfectly happy with.

E)

Something about you that brings people to you to be adopted. How do you see this clinically – this issue of adoption? The being with. The sense of the patient having you with them over the weekend even when they are separate from you. They have this feeling of you being with them, that’s strengthening which is empowering for the patient’s sense of self.

J)

Yes, all of that. And, I just think that people form an explicit fantasy of adoption or may very well have an implicit fantasy of adoption. Those of my two very recent ideas.

E)

I know that our shared patient experiences you as a father-figure that, in so many ways, has been sustaining for her.⁴

J)

Those are the two ideas. I think my coauthors will probably want to kill me. Here I go stirring the pot again. (Laughing)

E)

(Laughing) You call them up and tell them you have these new ideas that need to be engaged. Your collaboration with Frank and Jim has been very powerful, hasn’t it?⁵

J)

Yes. Let’s leave that. Now, what are we going to do with this interview?

E)

This interview will be transcribed and will be published in an issue of Psychoanalytic Inquiry.

J)

Good!

E)

What do you want to say?

J)

I would like to know, I’m very curious, to have as much as possible a sense of your picture of what it was like for you when we started. What I said, how did it strike you?

E)

As I told you the other night, I had been trying to get into supervision with you but you were busy and did not have time. And, of course, you did not know me. Finally, in 1988 you had an opening and we started. At the time, I was at the beginning of my third year in a four-year psychoanalytic psychotherapy training program affiliated with the Washington Psychoanalytic Institute, which was primarily classical. I had a supervisor who was classical. Basically, his approach involved viewing whatever the patient was talking about as a defense against what was not being talking about. For example, if the patient was talking about concerns that were not focused on transference material, the patient was seen as defending against transference feelings and reactions. If the patient was focused on the past, he or she was avoiding the present or vice versa. As I experienced it, his recommendation was to go to where the patient was not – to name and interpret defenses – rather than to go to where the patient is as the beginning point of exploration. Although, I tried to follow his recommendations, they did not feel right to me. It was with a sense of fresh air that when I began with you and with your recommendation of beginning with where the patient is as the starting point. You told me that engaging a patient that way would deepen the work. Your idea to be with where the patient is appealed to me and made a great deal of sense to me. I looked today – we began in 1988, Psychoanalysis and Motivation, was published in 1989. I’m not sure if you were still working on the book or you had finished it, but I had great affinity for your developmental approach. You taught me how to use developmental findings to enter a patient’s experience as it was unfolding in a session. You pointed me toward papers to read.

Overall, it was an experience of learning about developmental theory and findings but, primarily, it was about how to bring a developmental understanding into moment-to-moment clinical interactions, over and over again. I would write a process note and bring it in and we discussed the session. I feel I learned a language of being with the patient in such an exquisite way. That was our beginning. I think we had an affinity for each other from the beginning.

J)

Oh, yes. That is helpful to hear. How did you get my name?

E)

I got your name from several people. But Marilyn Voigt was an analysand of yours and a friend of mine.⁶ She spoke very highly of you and of her experience with you. You were known as an expert in narcissism. For me, your Motivational Systems Theory made so much sense. As do the formulations of your guidelines for clinical engagement. I want to talk with you about those as well – how you developed them. When I attend conferences or read articles, wearing the attribution, for example, is now part of the psychoanalytic lexicon and that comes from you.

J)

That came from me and model scenes came from me.

E)

Yes, absolutely – wearing the attribution and model scenes.

J)

There was simultaneity in that as we were working together, my ideas were maturing as well. But I found you, at the beginning, very limited in your thinking. Not because your mind is limited but I think you were trying to be a good girl and do what they had taught you to do – you were there after all – even if it did not feel entirely right to you. As we continued, step by step by step, I felt you broadened your thinking and became more and more flexible as we went along. Tolerating various new ideas and opening up to alternative possibilities can make people anxious; but I felt to whatever degree that was making you anxious, I was reassuring you that this is good stuff. You really should open your mind to this stuff!

You don’t listen to a patient without valuing what the patient is saying and figuring out what you are going to give emphasis to in order to help the patient. So, in any given hour, there is likely to be a dynamic point that gives some centrality to the theme and that is what I am listening for. So, I might say, into about a quarter of the hour, with a supervisee, tell me again what the patient said. “Oh, okay. I think the patient is saying that the main thing they are struggling with is anger with father for leaving the marriage and that is the one thing she is trying to get at.” And then we can discuss how the rest of the hour is somehow connected to that. And, if I speak to that or recommend speaking to that, it is to open up what I think is the central issue. Dan Stern viewed things very similarly.⁷

E)

The other thing I learned from you is a discipline that I bring to my own clinical work as well as to my work in supervising. This involves the discipline to follow very carefully what the patient is saying, developing an idea about the importance and the meaning of what is being communicated, and going on to speak about it with the patient. I might say something like, “It seems to me that I am hearing something important,” and then I go on to share what I think is the important issue and then I closely follow what happens next. Paying attention to the sequence of the patient’s response in a session and tracking sequences throughout a session as well as over a series of sessions is a central aspect of what you taught me and what I find to be so important.

J)

If you focus on what is happening, you are talking about experience and that makes a great deal of difference. And if you say, let’s look at what’s happening between us. For example, if the patient is talking in an animated way and suddenly the vitality goes out of the room. So, you might say to the patient, “Are you aware that when you came in and you were telling me about so and so, there was a lot of vitality in your voice and now it’s gone. Was my saying x or y something that affected you? I’m not sure, but I am noticing a change and am wondering what might have occurred between us.

E)

You are communicating you are noticing a shift in the patient’s experience and being curious about it.

J)

I might go on to say, perhaps you were feeling I was being oppositional instead of being responsive. And, I can see how you might have experienced me in that way. Although unfortunately, you frequently see me as deliberately oppositional and we have to clear that hurdle every time.

E)

And, you would say that with an openness for the patient to be able to say back to you with an openness that, “It’s just that” or “No, it’s something else.” You express it as an invitation to think about what’s going on between us together. That’s part of the we, isn’t it?

J)

This is reminding me of a time I was sitting in a lecture, Anna Freud was on the lectern. One of my collaborators was across the room and I went over to speak to him. Maurice Katan jumped up in front of me, with his finger wagging in my face, he said, “Joe, you wrote this and this about Freud. You cannot say these things about Freud.”⁸ I’m thinking should I bite it or not? (Laughing)

E)

He’s wagging his finger and you are thinking whether to bite it or not? (Laughing)

J)

So, I say, “Maurice, what you are telling me is so brilliant, I can’t get it so please write it to me.” And then, I took off. That was the nature of many of the Europeans – they brought the word from God. That heavy-handed domination was very much there along with their demand for submission – both were very much there.

E)

When was this?

J)

In the 1960s.

E)

Even then, you were having your own ideas that were different from the word of God.

J)

I wrote a review of Kohut’s, The Analysis of the Self.⁹ In it I say, this will be a classic, and I also say, the new theory and new approach is brilliant but that the hanging over of trying to include the old stuff won’t work.

E)

In October 1979, there was a big conference at UCLA that I attended and Kohut spoke. People were begging Kohut not to discard the old ideas. You are saying, in your review, you were able to see that this was not going to hold together and that there had to be a break with the old ideas.

J)

It’s the same issue as defense. Paul Grey, local guy here, was big, big on defense.¹⁰

E)

Your ideas have been welcomed.

J)

Eventually. I get quoted every day – I receive notifications every day of being quoted.

E)

We’ve been talking about 40 minutes. We can go two ways – what do you think is your legacy to psychoanalysis? What do you think is the future of psychoanalysis?

J)

I think my legacy will be the seven motivational systems and all the new ideas about the importance of the sense of power. And, the book on autism.¹¹

E)

I would add one more. Oh, we can add two more. Psychoanalytic Inquiry and ICP+P.

J)

Of, course. I would hope my legacy would include a way of thinking. I’m trying to think of the right word. Synthesizer – that’s the right word. I see a relationship between this and this and this and then I find some commonality.

E)

And it is that capacity, that vision which has been so important to your contributions. Your contributions grow out of that way of thinking.

J)

I will change any idea at any time if a better or clearer idea comes to me.

E)

That flexibility and openness is such an important part of your creativity. Thank you, Joe.

Afterword

I saw Joe two more times before his death, the last being May 9, 2021. A good friend and collaborator, Marie Hellinger, and I visited Joe. His physical condition was worsening and the quality of his life increasingly involved suffering and disability. Despite that, we spent a very pleasant afternoon reminiscing with Joe about his family and his youth. The following week, I was leaving for a vacation and knew this would probably be the last time we would be together. Near the end of our visit, Joe began speaking about the music of his youth and asked if we would like to view one of his favorite big bands, The Glenn Miller Band. We enthusiastically agreed and Joe played one of his favorites, “Gal from Kalamazoo,” on his i-Pad. Joe’s face lit up with joy and pleasure as we watched the band perform and listened to the music. This is my final memory of being with Joe – a memory I will always treasure as it captures so well Joe’s great capacity to play with others as well as expressing his love of creativity and his capacity to live and enjoy a full life. I am forever grateful for the presence of Joe in my life.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Joseph D. Lichtenberg

Joseph D. Lichtenberg, M.D. (1925–2021), was the co-founder and Editor-in-Chief of Psychoanalytic Inquiry, Director Emeritus of the Institute of Contemporary Psychotherapy and Psychoanalysis, past President of the International Council for Psychoanalytic Self Psychology, and member of the Program Committee of the American Psychoanalytic Association. He has authored and edited numerous books and articles, including Psychoanalysis and Motivation, Craft and Spirit: A Guide to the Exploratory Psychotherapies and From Autism and Mutism to an Enlivened Self.

Elizabeth M. Carr

Elizabeth M. Carr, APRN, MSN, BC, is an Associate Editor of Psychoanalytic Inquiry. She is a Director Emeritus of the Institute of Contemporary Psychotherapy and Psychoanalysis in Washington, D.C. and Co-Chair of the Psychoanalytic Training Program. She serves on the Advisory Board of the International Association of Psychoanalytic Self Psychology.

Notes

¹ Joe co-founded ICP+P with Rosemary Segalla in 1994.

² Joe wrote: “I conclude with a final word of appreciation for Carr. The coherence of her narrative about Aaron and about herself is neither accidental nor incidental. The case material comes alive… Carr’s careful monitoring and mirroring of his proto-affective indicators helped him begin to animate his feelings. Together, they could then begin to recognize, not only shame in its searing form, but anger, rage, fear, and depression, and love for his dog, and a sustaining respect for Carr (Lichtenberg, 1999, pp. 418–419, Italics in the original).”

³ Ron Bodansky is an American psychoanalyst living in Germany who developed a close and enduring friendship and mentorship with Joe.

⁴ Several years ago, a long-term patient of Joe’s expressed concern, given his age, about losing him and being without left without needed support if something were to happen to him. Joe suggested she begin to work with me. At first, the patient and I met when Joe was absent but gradually, she began to see both of us separately. My presence and involvement have helped her weather the terrible loss of Joe not being in her life.

⁵ Joe and his collaborators, Frank Lachmann and James Fosshage, published ten books together.

⁶ Marilyn Voigt is a retired clinical social worker in Washington, DC who received analytic treatment from Joe. Later, she became a Founding Member of ICP+P.

⁷ Daniel Stern was a psychoanalyst and infant researcher who made ground-breaking contributions to the field.

⁸ Maurice Katan was a psychoanalyst who immigrated from Europe to the United States.

⁹ Heinz Kohut was a psychoanalyst who immigrated from Vienna to Chicago following the Anschluss to escape Nazi persecution. Kohut developed this own theory, the psychology of the self and The Analysis of the Self was the first of several ground-breaking books.

¹⁰ Paul Grey is a psychoanalyst in Baltimore, MD.

¹¹ Lichtenberg, J. & Thieist, D. (2018). From Autism and Mutism to an Enlivened Self: A Case Narrative with reflections on Early Development. London and New York: Routledge.